<form class="form-horizontal form-validate form-modal" method="post" action="{:url('apply')}">
    <div class="modal-dialog image-list">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal">&times;</button>
                <h4 class="modal-title">提现申请</h4>
            </div>
            <div class="modal-body">
                <div class="col-sm-6">
                    <div class="form-group">
                        <label class="col-sm-3 control-label">开户银行：</label>
                        <div class="col-sm-5 m-t-mc">
                            {$supplyer.bank_name}
                        </div>
                    </div>

                    <div class="form-group">
                        <label class="col-sm-3 control-label">账户名称：</label>
                        <div class="col-sm-5 m-t-mc">
                            {$supplyer.bank_account}
                        </div>
                    </div>

                    <div class="form-group">
                        <label class="col-sm-3 control-label">手续费：</label>
                        <div class="col-sm-5 m-t-mc">
                            {$supplyer.withdrawal_rate}%
                        </div>
                    </div>
                </div>
                <div class="col-sm-6">
                    <div class="form-group">
                        <label class="col-sm-3 control-label">开户支行：</label>
                        <div class="col-sm-5 m-t-mc">
                            {$supplyer.bank_branch}
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-3 control-label">银行卡号：</label>
                        <div class="col-sm-5 m-t-mc">
                            {$supplyer.bank_number}
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-3 control-label">账户余额：</label>
                        <div class="col-sm-5 m-t-mc red">
                            ￥{$supplyer.balance_money}
                        </div>
                    </div>
                </div>
                <div class="col-md-12">
                    <div class="form-group">
                        <label class="col-sm-2 control-label">提现金额：</label>
                        <div class="col-sm-9">
                            <input name="money" type="number"  class="input-large">
                        </div>
                    </div>

                </div>
            </div>
            <div class="modal-footer">
<!--                <input type="hidden" name="log_id" value="{$row.log_id|intval}"/>-->
<!--                <input type="hidden" name="operating" id="operating" value="note"/>-->
                {eq name="row.status" value="0"}
<!--                    <button type="button" class="btn btn-primary operatbtn" data-type='refuse'>拒绝申请（退回积分）</button>-->
<!--                    <button type="button" class="btn btn-primary operatbtn" data-type='pay'>已打款</button>-->
                {/eq}
<!--                <button type="button" class="btn btn-primary operatbtn" data-type='note'>提交申请</button>-->
                <button type="submit" class="btn btn-primary postBtn" data-loading-text="保存中..." disabled>提交申请</button>
                <button type="button" class="btn btn-default" data-dismiss="modal">取消</button>
            </div>
        </div>
    </div>
</form>
